Biblical Counseling for Bulimia

It is no secret that I'm a believer in biblical counseling. NANC, the National Association of Nouthetic Counselors, is the biggest and most organized body of certified biblical counselors in the United States and abroad (check the link to the right - there is a directory of counselors arranged by state, province and country).

Why biblical counseling?

For one thing, biblical counselors promote a high view of God. Often, in therapy or inpatient centers that clam to be "faith-based" or "Christian", the patient is actually encouraged to envision God any way she would like (think of the 12-Step programs' caveat of "higher power" or "God, however we imagine Him to be".) Scripture is clear about God's nature, attributes, conditions for blessings, and expectations on His children. This is not to say there isn't a sense in which God's grace is common and His love unconditional. God loves the prodigal with an unfathomable depth of mercy, but the wayward sinner is called to repentance. We are not to remake God in our own image, but rather worship Him as He has revealed Himself to be. Any other option leaves us worshiping a false god and a contrived "jesus".
Biblical counseling deals with sin. Unlike secular counseling, which takes God and His Word completely out of the equation, or integrationist "Christian" counseling which inadvertently makes the bulimic more comfortable in her sin, biblical counseling confronts the sin head-on and helps the eating disordered girl (or woman) recognize the ungodly thought patterns and beliefs that led to the behavior in the first place. Calling bulimia (which is self-destructive, idolatrous and evidences lack of self-control) a sin is not condemning - we all sin. I sin every day, despite the fact that I haven't thought of purging in 6 years. (I once actually believed that if I overcame my addictions to food and alcohol, I would be the World's Best Christian. Hah! Ask my husband. Still hasn't happened).

Realizing that bulimia, like drunkenness, is a sin rather than a disease or genetic predisposition should come as a relief to the bulimic who wishes to put it to death. Sin can be confessed as such, repented of, and forgiven. Look at it logically: there is no sin that cannot be forgiven. Scripture commands us to repent (turn away from) our sin, and assures us that when we take it to God, we will meet with mercy and grace - not condemnation. Since we are urged to repent, is it possible there is a s in that we cannot turn from? NO. God would never instruct us to do something He has not given us the means to accomplish.

Finally, biblical counseling provides accountability. Particularly besetting sins such as eating disorders typically take a bit of time to be put to death entirely. Renewing one's mind with the washing of the Word requires consistency and discipline. A nouthetic counselor gives her client homework, including reading from the bible, personal reflections, and memorization of key passages. The assignments are tailored to the type of spiritual battle the client is waging, and they pray together as well as examine what the Bible says. No provision is made for rationalization of the behavior or humanistic philosophies of the personality. Biblical counseling upholds the Scriptural position that this type of discipleship should take place in conjunction with the local church.

Why Group Therapy is Unbiblical

Common secular (and faith-based) treatment of addictions, including eating disorders, incorporates some sort of "group therapy" or support group. However, in my study of nouthetic counseling and particularly in reading Jay Adams' material, I have come to the conclusion that such an approach is unbiblical and should therefore be avoided. In "Competent to Counsel", Adams quoted an agnostic psychologist as saying that group sessions typical devolve into a cathartic, collective confessional for the participants, with no real solution to their problem. Keep in mind that "Compentent to Counsel" was written in the late sixties - well before the rise in popularity of the "culture of confession" we see on Oprah!

In my own experience, back in my college days when I was forced to attend various groups, I have personally witnessed the uselessness of this type of "therapy". Facilitated by a compassionate woman with a background in behavioral psychology, a typical group will hhave around a dozen girls and women of various ages feeling very sorry indeed for themselves and each other. Some truly want to change; others are there against their will. Regardless of background or motive, they all have one thing in common: they are either anorexic or bulimic (or some combination of both). Common sense dictates that when you have a group of individuals involved in aberrant (or unhealthy) behavior thrust together, a sort of comraderie will develop. This has both positive and negative effects: while the participants may benefit by shared compassion and the ability to be vulnerable, what prevails is a sense of "us versus them" - a strength in numbers mentality that makes it less likely any of the group participants will actually forsake her unhealthy eating patterns. Never is the focus put on the solution - new life in Christ. The focus remains squarely on the individual, and since we love to talk about ourselves, it stays there.

The net result of a "support group" is to make the bulimic morbidly introspective and even more firmly entrenched in her eating disorder. BT, DT.

Since group therapy never directly confronts the sin issue inherent in bulimia, the noetic effect of sin makes it all the easier for the participants to gradually rationalize their behavior. The enabling effect of the group is rarely overt - tips on effective purging and water-loading will not be tolerated - but the women, seeing so many others with the exact same problem, have no real incentive to change. As sin is personal, so is repentance. Ultimately, each one of us must truly grow to hate our particular sin (by seeing it through God's eyes) and get on our knees before Him. The role of a biblical counselor is to walk beside the struggling Christian as she recognizes the root of her behavior and resolves to live for Christ.

* Nouthetic counseling comes from the Greek word "noutheo", which generally is translated "to admonish". However, the term, coined by Jay Adams, encompasses more than a general admonition. The idea behind nouthetic counseling is that since sin is behind most of the problems and sufering Christians struggle with in their day to day life, by identifying and confronting the specific sin, rebuking the unscriptural beliefs that have spawned it, and exhorting and encouraging the client to repent of the behavior and seek God, the individual's heart will be changed and the sin abandoned. The Bible is rightly seen as the ultimate authority and is consulted as the ideal pattern for relationships and behavior.